HomeMy WebLinkAbout961248.tiff ACOItILe !1:!'iltERTIFICATEEOFIINSURANCEiwliliiiiliiliimnsimenninisliii
ISSUE DATE(MM7DD/1'Y)
, rJ 06/27/96
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE Anderson-Ban Insurance, Inc. DOES NOT AMEND,,EXTEND OR ALTER THE COVERAGE A FORDED BY THE
600 S. CHERRY ST. STE. 220 POLICIES BELOW.
COMPANIES AFFORDING COVERAGE
Denver, CO 80222
(303) 322-2860 COMPANY A
LETTER Employers Mutual
COMPANY B
INSURED LETTER American Compensation Ins (RTW)
H2O Construction & Maintenance COMPANY C
1407 Chase St LETTER
COMPANY D
Lakewood CO 80214 LETTER
( 303) 238-8937 COMPANY E
LETTER
COVERAGES :' S..
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE F� THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 3
LTR POUCY EFFECTIVE POUCY EXPIRATION
TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/1'Y) DATE(MMNDNY) LIMITS
A GENERAL LIABILITY GENERAL AGGREGATE (s2,000, 000
X COMMERCIAL GENERAL LABILITY PRODUCTS-COMP/OP AGO. s2 , 000,000
CLAIMS MADE X OCCUR 1D30899 07/01/96 07/01/97 PERSONALS ADV.INJURY I$1,000,000
OWNERS&CONTRACTORS PROT. EACH OCCURRENCE $1,000, 000
X Aggreg per Job FIRE DAMAGE(Any one fire) $ 50,000
MED.EXPENSE(Anyoneperson) $ 5,000
A AUTOMOBILE UABILITY COMBINED SINGLE
X ANY AUTO UMIT $1,000, 000
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
X HIRED AUTOS 1E30899 07/01/96 07/01/97 BODILY INJURY
(Per accident) $
X NON-OWNED AUTOS
GARAGE LIABILITY
PROPERTY DAMAGE $
A EXCESS UABILITY EACH OCCURRENCE $1,0 0 0, 000
X UMBRELLA FORM 1J30899 07/01/96 07/01/97 AGGREGATE $1,000,000
OTHER THAN UMBRELLA FORM
B I STATUTORY LIMITS
WORKER'S COMPENSATION ACWC003198 07/01/96 07/01/97 EACH ACCIDENT $500,000
AND DISEASE--POLICY LIMIT $500, 000
EMPLOYERS'LIABILITY DISEASE-EACH EMPLOYEE $500,000
OTHER
/ / / /
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
Certificate holder is additional insured on general liability as respects
their interests in work performed by or on behalf of named insured.
CERTIFICATE t OLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
Weld County £ MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
915 10th St LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
Greeley CO 80631 f;: LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
::AUTHORIZED
REPRESENTATIVE
e39(,y^' ' 111 72j4 'ACOHD 25-S{T . Lam'
961248
C)7/03/q,
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